Coping with the Side Effects of Androgen Deprivation Therapy for Prostate Cancer
by Sylvie Aubin, PhD
Androgen deprivation therapy is a commonly prescribed treatment option for men diagnosed with prostate cancer. It consists of suppressing or stopping the production of male hormones and usually results in a decrease of the prostate-specific antigen, an important marker of cancer activity. Treatment approaches may include surgical removal of testes or drugs administered on a continual or intermittent basis.
Despite its beneficial effect on the PSA and potential for keeping the cancer stable for many years, ADT presents a number of physical and psychosocial side effects that can negatively affect the quality of life of men and their partners. The most common side effects include loss of sexual desire or libido, problems in getting or maintaining erections, and hot flashes.
Although faced with sexual changes, many couples do not give up their sexual lives. In essence, sexually active couples can learn to prioritize and enhance intimacy. Strategies may include mutual communication of love, affection, needs, and desires; openness to alternate ways of eliciting sexual desire and arousal; planning quality time; and working together to address erectile dysfunction or orgasm problems. Couples may increase their chances of success by working with a mental health professional who specializes in sexual oncology.
The presence of sudden, intense hot flashes may also hinder intimacy. Partners often notice a significant decrease in their physical proximity or in the time they spend cuddling, hugging, or holding each other. Hot flashes may also trigger feelings of embarrassment, frustration, or rejection. Fortunately, effective treatment options are available to alleviate hot flashes.
The most common side effects include loss of sexual desire or libido, problems in getting or maintaining erections, and hot flashes.
In addition, men may experience dramatic changes in the way they feel physically and emotionally. Physically, men may complain of aches and pains, fatigue, and a lack of energy. Emotionally, men may report feeling more sensitive or unstable, with alternating emotions ranging from sadness with sudden tearfulness to feeling depressed or anxious, irritable, and short-fused.
Lack of energy, emotional instability, and other behavioral changes may signal depression since ADT places men at greater risk of developing clinical depression or mood disorders. Their partners are also at risk, especially if men fail to recognize and address mood changes. Escalation of symptoms in either partner can be prevented. Talk to your doctor about the various signs of depression, and seek a treatment approach combining medication and cognitive behavior therapy.
Other side effects of ADT may include changes in mental abilities, or cognitive function. Complaints may range from increased forgetfulness to distractibility to difficulties in spatial abilities. Fortunately, symptoms do reverse with time after cessation of ADT. Antidepressants may be beneficial in improving mental acuity, focus, and concentration. Other helpful strategies include learning memory techniques and practicing mentally challenging activities. Effectively managing frustration and anxiety also may help.
Lastly, a series of physical changes may take place following ADT. These include weight gain, gynecomastia (growth of breasts), loss of muscle mass and strength, hair changes, and decreased size in testicles and penis. Non-visible changes may include loss of bone density, anemia and metabolic alterations associated with serum lipids, exacerbation of hypertension, diabetes, and heart disease.
Visible physical changes can significantly alter body image and decrease self-esteem. Combined with other side effects, impairments in physical appearance often generate emotions of frustration and helplessness and contribute to mood changes. A number of interventions can minimize or prevent significant physical changes. They include aerobic and resistance exercise under the supervision of a physical therapist or licensed personal trainer, regular nutrition consults, and prophylactic radiation to the breast tissue prior to initiating ADT. It is important to address these potential physical changes before starting ADT so that participation in available interventions takes place early on.
A number of treatment options are currently available to minimize the side effects of ADT and allow men and their partners to maintain their quality of life. Additional strategies may include nurturing relationships, building skills to effectively manage negative thoughts and emotions, and maintaining regular exercise and healthy dietary habits.
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Dr. Sylvie Aubin is an assistant professor in the department of Oncology at McGill University in Montreal, Quebec, Canada.
This article was published in Coping® with Cancer magazine, January/February 2011.